MetLife Accidental Death & Dismemberment (AD&D) Plan
Provides benefits for you or your insured dependents in the event of a covered accident — on or off the job — which results in loss of life, limbs, use of limbs, eyesight, hearing or speech.
This benefit is not offered to employees represented by AFSCME
Customer Service
1 (305) 995-7029
mybenefits.metlife.com
Service Hours (EST):
| M-F | 8am – 4:30pm |
Claims
1 (800) 638-6420; #2
1 (305) 995-7190
Service Hours (EST):
| M-Th | 8am – 8pm |
| Friday | 8am – 5pm |
Accidental Death and Dismemberment (AD&D)
Accidental Death and Dismemberment (AD&D) provides benefits for you or your insured dependents in the event of a covered accident—on or off the job—which results in loss of life, limbs, use of limbs, eyesight, hearing or speech. You may select $25,000 to $500,000 (in $25,000 increments) of coverage.
You must be enrolled for coverage in order to cover your dependents. Your dependent’s coverage is a percentage of your selected benefit amount. They are as follows:
Spouse – The spouse’s benefit amount will be 40 percent of the employee’s, or 50 percent if the employee has no dependent children. This amount cannot exceed $250,000.
Children – Each covered child’s benefit amount will be 10 percent of the employee’s, or 15 percent if the employee has no spouse. The maximum children’s benefit is $25,000.
Benefits will be reduced based upon the age of you or your spouse:
- If you are at age 65, to 65% of the original face value of the coverage amount in force
- If you are at age 70, to 50% of the original face value of the coverage amount in force
NOTE: Premiums will be adjusted.
Summary of Benefits
Covered Accidents and Bodily Injuries
Accidental Death and Dismemberment (AD&D) will pay the following percentage of the amount of coverage you purchase (from $25,000 up to $500,000 for employee coverage) if, within 365 days of an eligible accident, bodily injuries result in:
| Loss of life | 100% |
| Total paralysis of arms and legs | 100% |
| Loss of any combination of two: hands, feet or eyesight | 100% |
| Loss of speech and hearing in both ears | 100% |
| Loss of arm/leg permanently severed at or above elbow/knee | 75% |
| Total paralysis of both legs | 50% |
| Total paralysis of arm and leg on one side of the body | 25% |
| Loss of one hand, foot or sight in one eye | 50% |
| Loss of speech or hearing in both ears | 50% |
| Loss of thumb and index finger on the same hand | 25% |
For example, if you purchase $200,000 in coverage for yourself and you are in an accident that results in your death, the benefit would pay $200,000. If the accident results in total paralysis of both your legs, the benefit would pay $100,000. If the accident results in loss of your thumb and index finger on the same hand, the benefit would pay $50,000. If you or a dependent sustain more than one covered loss due to an accidental injury, the amount we will pay will not exceed the full amount.
Accident and Bodily Injuries Not Covered
Benefits will not be paid for a loss caused by or resulting from:
- Sickness, physical or mental illness or infirmity, or the diagnosis or treatment of such illness or infirmity;
- Infection, other than infection occurring in an external accidental wound;
- Suicide or attempted suicide; intentionally self-inflicted injury;
- Service in the armed forces of any country or international authority, except the United States National Guard;
- Any incident related to:
- travel in an aircraft as a pilot, crew member, flight student or while acting in any capacity other than as a passenger;
- travel in an aircraft for the purpose of parachuting or otherwise exiting from such aircraft while it is in flight;
- parachuting or otherwise exiting from an aircraft while such aircraft is in flight except for self preservation;
- travel in an aircraft or device used for testing or experimental purposes; by or for any military authority; or for travel or designed for travel beyond the earth’s atmosphere;
- Committing or attempting to commit a felony;
- The voluntary intake or use by any means of:
- any drug, medication or sedative, unless it is: taken or used as prescribed by a Physician, or an “over the counter” drug, medication or sedative, taken as directed;
- alcohol in combination with any drug, medication, or sedative; or
- poison, gas, or fumes; or war, whether declared or undeclared; or any act of war, insurrection, rebellion, or riot; or driving a vehicle or other device while intoxicated as defined by the laws of the jurisdiction in which the vehicle or other device was being operated
- Exclusion for Intoxication
We will not pay benefits under this section for any loss if the injured party is intoxicated at the time of the incident and is the operator of a vehicle or other device involved in the incident.
Intoxicated means that the injured person’s blood alcohol level met or exceeded the level that creates a legal presumption of intoxication under the laws of the jurisdiction in which the incident occurred.
Benefits Eligibility
- All Full-Time employees are eligible to enroll in AD&D Insurance offered by the School Board.
- Current Retirees may only continue to enroll in the AD&D insurance if you were previously enrolled at the time of your retirement.
- COBRA Participants and employees under the AFSCME bargaining units are ineligible to enroll in AD&D insurance.
Other Benefits Offered through this Policy
Seatbelt
When it applies
Upon death from injuries sustained in an accident while driving or riding as a passenger in a passenger car*, provided the person was wearing a properly fastened seat belt that meets published, US Government safety standards, is properly installed by the manufacturer and has not been altered after installation, at the time of the accident.
* Passenger car is any validly registered four-wheel private passenger car. It does not include any commercially licensed car or a private car that is being used for commercial purposes, recreation or professional racing.
Amount
An additional 10 percent of the benefit amount up to $25,000; minimum amount is $1,000. The correct position of the seat belt must be certified by the investigating officer or included in the official accident report and a copy of the police report must be submitted with a claim for this benefit.
Education
When it applies
The Child Education Benefit provides an additional benefit equal to the tuition charges for each eligible dependent child to attend college or another accredited institution for up to 4 consecutive years as long as the child is: enrolled in an accredited college, university or vocational school above the 12th grade level at the time of the employee’s accidental death; or is at the 12th grade level and, within one year after the employee’s accidental death, enrolls as a full-time student in an accredited college, university or vocational school.
Amount
The benefit amount will not exceed $5,000 per year and an overall maximum of 2% of the employee’s AD&D Full Amount.
If at the time of the accident there are no dependents who qualify for the education benefit, the plan will pay an additional benefit of $1,000 to the designated beneficiary.
Spouse Training
When it applies
If your spouse is enrolled in an accredited school on the date of your death or enrolls in such a school within 12 months of the date of your death.
Amount
The additional amount we will pay is equal to the tuition charges for 1 academic year up to $5,000 per year. The overall maximum additional benefit is 2% of the AD&D Full Amount.
If there is no Spouse who qualifies, $1,000 will be paid to the beneficiary.
COBRA Continuation
When it applies
If benefit is paid for a covered loss of your life.
Amount
Up to $4,500 reimbursement per year for three (3) years. Minimum amount is $1,000 and maximum amount is 3% of the full amount.
Hospital Confinement
When it applies
This benefit becomes payable if a covered person is confined in a hospital as a result of an accidental injury.
Amount
Pays an additional monthly benefit equal to 1% of the AD&D Full Amount the lesser of or $2,500. Benefits will be determined on a pro-rate basis for partial month of confinement. If more than one confinement for any one accident, we will pay for just one hospital confinement. We will pay for the first confinement while under doctor’s care.
Child Daycare Benefits
When it applies
The Child Care Benefit provides an additional amount equal to the Child Care Center* for each eligible dependent child, 11 years of age or younger, to attend a licensed Child Care Center for up to 4 consecutive years as long as the eligible child is enrolled in a Child Care Center at the time of the employee’s accidental death.
Amount
Additional amount equal to the Child Care Center* charge up to a maximum of $7,500 per year and an overall maximum of 3% of the AD&D Full Amount.
* Child Care Center means a facility that is operated and licensed according to the law of the jurisdiction where it is located and provides care and supervision for children in a group setting on a regularly scheduled and daily basis.
This benefit is paid quarterly when MetLife receives proof that Child Care Center charges have been paid. Payment is made to the person who pays the charges on behalf of the Child.
Value-Added Features
Air Bag Benefit
If an Air Bag is deployed for the covered person during the accident and the covered person dies as a result of the accident while driving or riding in a passenger car* and wearing a properly fastened seat belt, we will pay an additional benefit of 5% of the AD&D Full Amount to a maximum of $10,000. When the Air Bag Benefit and the Seat Belt Benefit both apply, the combined additional benefit will not exceed 15% of the AD&D Full Amount, to a combined maximum of $20,000.
* Passenger Car is any validly registered four-wheel private passenger vehicle. It does not include any commercially licensed car; or a private passenger car that is being used for commercial purposes, or any vehicle used for recreational or professional racing.
Brain Damage Benefit
Brain Damage is a covered loss that pays a benefit equal to 100% of the AD&D Full Amount as long as the brain damage* manifests itself within 30 days of the accidental injury, the covered person requires hospitalization for at least 5 days and brain damage persists for 12 consecutive months after the injury.
* Brain Damage means permanent and irreversible physical damage to the brain causing the complete inability to perform all the substantial and material functions and activities normal to everyday life.
Child Care Benefit
The Child Care Benefit provides an additional amount equal to the Child Care Center* charge up to a maximum of $7,500 per year and an overall maximum of 3% of the AD&D Full Amount for each eligible dependent child, 11 years of age or younger, to attend a licensed Child Care Center for up to 4 consecutive years as long as the eligible child is enrolled in a Child Care Center at the time of the employee’s accidental death.
If no child qualifies, $1,000 will be paid to the covered person’s beneficiary.
* Child Care Center means a facility that is operated and licensed according to the law of the jurisdiction where it is located and provides care and supervision for children in a group setting on a regularly scheduled and daily basis.
This benefit is paid quarterly when MetLife receives proof that Child Care Center charges have been paid. Payment is made to the person who pays the charges on behalf of the Child.
Child Education Benefit
The Child Education Benefit provides an additional benefit equal to the tuition charges for each eligible dependent child to attend college or another accredited institution for up to 4 consecutive years as long as the child is: enrolled in an accredited college, university or vocational school above the 12th grade level at the time of the employee’s accidental death; or is at the 12th grade level and, within one year after the employee’s accidental death, enrolls as a full-time student in an accredited college, university or vocational school. The benefit amount will not exceed $5,000 per year and an overall maximum of 2% of the employee’s AD&D Full Amount.
If at the time of the accident there are no dependents who qualify for the education benefit, the plan will pay an additional benefit of $1,000 to the designated beneficiary.
Coma Benefit
Coma is a covered loss that provides a benefit amount of 1% monthly of the AD&D Full Amount up to a maximum of 60 months if a covered person goes into a coma* as a result of an accidental injury and independent of other causes. Such state must begin within 30 days of the accidental injury and continue for 7 consecutive days.
* Coma means a state of deep and total unconsciousness from which the comatose person cannot be aroused.
Common Carrier Benefit
The Common Carrier Benefit pays an additional benefit in an amount equal to 100% of the AD&D Full Amount if a covered person dies as a result of an accidental injury while traveling in a Common Carrier*.
* Common Carrier means a government regulated entity that is in the business of transporting fare-paying passenger. This does not include chartered or other privately arranged transportation, taxis, or limousines.
Common Disaster Benefit for VADD
If the employee and the employee’s spouse are injured in the same accident and die as a result of injuries sustained in the accident, the spouse’s benefit amount will be increased to 100% of the VAD&D Full Amount payable for the employee’s loss of life.
* In Texas, Children age 25 only and Student age 25 only.
Exposure:
MetLife will deem a loss to be the direct result of an accidental injury if it results from unavoidable exposure to the elements and such exposure was a direct result of an accident.
Full Amount:
Regarding Accidental Death & Dismemberment, the scheduled dollar benefit amount for an accidental death and certain accidental injuries.
Hospitalized:
Includes inpatient hospital care, care in a hospice, intermediate or long-term care facility, or receipt of chemotherapy, radiation therapy, or dialysis treatment wherever performed.
Hospital Confinement Benefit
Hospital Confinement Benefit pays an additional monthly benefit equal to 1/30th of 1% of the AD&D Full Amount if a covered person is confined in a Hospital as a result of an accidental injury. Benefits begin on the 4th day of continuous confinement and are subject to a monthly limit of $2,500 and a maximum duration of 12 continuous months.
Benefits will be determined on a pro-rate basis for partial month of confinement. If more than one confinement for any one accident, we will pay for just one hospital confinement. We will pay for the first confinement.
* Hospital means a facility which is licensed as such in the jurisdiction in which it is located and; provides a broad range of medical and surgical services on a 24 hour a day basis for injured and sick persons by or under the supervision of staff of Physicians; and provides a broad range of nursing care on a 24 hour a day basis by or under the direction of a registered professional nurse.
Presumption of Death
A person will be presumed to have died as a result of an accidental injury if the aircraft or other vehicle in which the person is traveling disappears, sinks or is wrecked and the person’s body is not found within 1 year of the date the aircraft or vehicle was scheduled to have arrived at its destination, or, if not a Common Carrier, the date the person was reported missing to authorities.
Spouse Education Benefit
If the Spouse is enrolled in an accredited school on the date the covered employee dies, or enrolls in such a school within 12 months of the employee’s death, the additional amount we will pay is equal to the tuition charges for 1 academic year up to $5,000 per year and an overall maximum of 2% of the employee’s AD&D Full Amount.
If there is no Spouse who qualifies, $1,000 will be paid to the beneficiary.
Seat Belt Benefit
Seat Belt Benefit provides an additional benefit equal to 10% of the AD&D Full Amount, subject to a minimum benefit of $1,000, up to a maximum of $25,000 if a covered person dies from injuries sustained in an accident while driving or riding as a passenger in a Passenger Car*, provided the person was wearing a properly fastened Seat Belt* at the time of the accident. When the Seat Belt Benefit and the Air Bag Benefit both apply, the combined additional benefit will not exceed 15%.
* Passenger Car: Any validly registered four-wheel private passenger car. It does not include any commercially licensed car; or a private car that is being used for commercial purposes, or any vehicle used for recreation or professional racing.
* Seat Belt means any restraint device that meets published, US Government safety standards, is properly installed by the car manufacturer and has not been altered after installation. The term also includes a child restraint device that meets the requirements of state law.
The correct position of the seat belt must be certified by the investigating officer or included in the official accident report, and a copy of the police report must be submitted with a claim for this benefit.
Plan Documents & Resources
Limitations and Exclusions
Benefits will not be paid for a loss caused by or resulting from:
- Sickness, physical or mental illness or infirmity, or the diagnosis or treatment of such illness or infirmity
- Infection, other than infection occurring in an external accidental wound;
- Suicide or attempted suicide; intentionally self-inflicted injury;
- Service in the armed forces of any country or international authority, except the United States National Guard;
- Any incident related to:
- travel in an aircraft as a pilot, crew member, flight student or while acting in any capacity other than as a passenger;
- travel in an aircraft for the purpose of parachuting or otherwise exiting from such aircraft while it is in flight;
- parachuting or otherwise exiting from an aircraft while such aircraft is in flight except for self preservation;
- travel in an aircraft or device used for testing or experimental purposes; by or for any military authority; or for travel or designed for travel beyond the earth’s atmosphere;
- Committing or attempting to commit a felony;
- The voluntary intake or use by any means of:
- any drug, medication or sedative, unless it is: taken or used as prescribed by a Physician, or an “over the counter” drug, medication or sedative, taken as directed;
- alcohol in combination with any drug, medication, or sedative; or
- poison, gas, or fumes; or war, whether declared or undeclared; or any act of war, insurrection, rebellion, or riot; or driving a vehicle or other device while intoxicated as defined by the laws of the jurisdiction in which the vehicle or other device was being operated.